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I^/,J <br />'�� <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257-8810 <br />Date 6-1-99 <br />Public Works Pertnit R <br />;!' <br />.T. <br />Buitding Petmit R 6)612 <br />� <br />FFA e z iom , . <br />TYPEORPRINTOM�Y eOSTING PubifaWorks`Fee$ ?%�f <br />�v . _ �c� �_i <br />� ���� :-.i .. <br />North Crest Development PO Box 340 Edmonde WA 98202 425-774-3181 <br />Owner Mailing Atldress Ciry Zip ,��- Phone <br />�i' , <br />Owner s - <br />ppPlicant Mailing Address . - . Gh' � " . ... .' . �Z�p: .. • ' Phone �, <br />Describe Proposed Work <br />PROJECTADDRESS (if known) 4627 21st Dr <br />Attach tour (4) copies plan, lor proposed work - Draw lo srale and note the tollowing it applicablo: <br />. properry Lines • Outline end dimensions oi all ezisting and proposed structures on the lot • Existing and proposed utilities <br />• Centedine of street • Indicate North • Show any proposed grading changes • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERM�T CONDITIONS: <br />1. All calis for inspection shall be made 24 hours in advance - phone (425) 257•8810 <br />2. Ali work shall be performed in accordance with this permit and current Ciry oi Everett Design and <br />Construction Standards and Specifications. , <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />� ki�.�p citv slrecls cican al a�l tinrs. <br />� Ciub r;uGcr and sidc«;dk in th� plat mr u;u :i�.,�d undama!,red, :ury d;iiu:ige thcreto sh�l( be rcplc�ad ;�t thr. <br />di�crGion oi tlic }libiic Worl:s L�spcctor <br />i� 'Ciic I'W In:pcctor tuus� approve ;ury� cfriu!�,r u� thc cuivcwsy cul. 'd%i�llli :�t prop linr linuhd lo �xi;lin� a' <br />u�dlh. <br />' Adju:t walri boxc, to grade at cnd of wnsanction. <br />,, Ihi+.;wnys sh;dl be complzi�:iv cwed beCorc dti•.:s�:,� ou them. <br />i� Rooliop drain:+cc =hall v: di;ciia�;;ed to Ili� �loru d�ain shib providcd ou iha lot. <br />n1 <br />�,K. � � <br />� <br />� <br />ACKNOWLEDGEMENT OF CANDITIONS <br />The undersigned ownerlapplicant hereby agrees to hold arW seve harmless <br />the Ciry oi Everett irom any and all claims lor damagas, coats, expenses, or <br />causes of acdon that may erise because of i�stelletlon and maintenance of ihe <br />improvement or other right�of-way use hereto appliad for and lurthei egrees lo <br />remove same upon notice from the City and ro replace puWic properry dem- <br />aged thereby. <br />iQ„��,Q� �e...__ (s �l 5/49 <br />S� a re o p ican e <br />��OMpLETi(NJ.lH�PERMR MAY BE CANCELLED BY TFE CRY UPON ANY 3���� OF WOFiFC ON THIS PRQECTOVEAR80 D WRATION.Y PURSUED i0 <br />